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目的:总结右外侧小切口剖胸矫治先天性心脏病(先心病)的经验,探讨右外侧切口在先心病的应用与推广。方法 :2002年1月至2011年10月,本手术组经右外侧剖胸小切口完成1 972例小儿先天性心脏畸形矫治。其中男性1 143例,女性829例。年龄平均38.7个月(3～489个月),体质量平均11.6 kg(4.8～69 kg)。主要病种:室间隔缺损、房间隔缺损及法洛四联症等。结果 :术后并发症81例(4.1%):低心排出量综合征(低心排)26例(死亡3例)、严重肺部感染22例(死亡2例)、二次开胸止血8例(死亡1例)、多脏器功能衰竭4例(死亡1例)、一过性脑功能障碍5例、术后残余分流6例(经原切口再次手术1例)、右膈神经麻痹5例(1例膈肌折叠)、术后房室传导阻滞4例(1例置永久起搏器)、乳糜胸2例。随访3～108个月,3例法洛四联症存在残余梗阻26～50 mmHg(1 mmHg=0.133 kPa)观察中,1例二尖瓣成型术后大量反流行二尖瓣置换。结论:先心病可以在右外侧剖胸小切口下完成,该入路安全可靠、创伤小、暴露好并恢复快。
Objective: To summarize the experience of right lateral small incision thoracotomy for congenital heart disease (CHD) and to explore the application and promotion of right lateral incision in CHD. Methods: From January 2002 to October 2011, a total of 1 972 cases of congenital heart deformities were treated in this operation group through the small incision of the right lateral thoracotomy. There were 1,143 males and 829 females. The average age was 38.7 months (range 3-489 months) with an average body weight of 11.6 kg (4.8-69 kg). The main diseases: ventricular septal defect, atrial septal defect and tetralogy of Fallot and so on. Results: Postoperative complications occurred in 81 cases (4.1%): low cardiac output syndrome (low cardiac output) in 26 cases (3 deaths), severe lung infection in 22 cases (2 deaths), secondary thoracotomy (1 case of death), 4 cases of multiple organ failure (1 case of death), 5 cases of transient brain dysfunction, 6 cases of postoperative residual shunt (reoperation after primary incision), 5 cases of phrenic nerve paralysis (1 case of diaphragmatic fold), 4 cases of atrioventricular block (1 case of permanent pacemaker) and 2 cases of chylothorax. Three to 108 months of follow-up, there were residual obstructions in 3 cases of tetralogy of Fallot from 26 to 50 mmHg (1 mmHg = 0.133 kPa), and a large number of retrograde mitral valve replacement occurred after mitral valve implantation. Conclusions: The congenital heart disease can be completed under the small lateral incision of the right lateral thorax. The approach is safe and reliable, with less trauma, better exposure and faster recovery.